The influence of demographic characteristics,living conditions,and trauma exposure on the overall health of a conflict-affected population in Southern Sudan

Background  

There remains limited evidence on how armed conflict affects overall physical and mental well-being rather than specific physical or mental health conditions. The aim of this study was to investigate the influence of demographic characteristics, living conditions, and violent and traumatic events on general physical and mental health in Southern Sudan which is emerging from 20 years of armed conflict.     

Effect of an armed conflict on relative socioeconomic position of rural households: case study from western Côte d'Ivoire

Background  

Current conceptual frameworks on the interrelationship between armed conflict and poverty are based primarily on aggregated macro-level data and/or qualitative evidence and usually focus on adherents of warring factions. In contrast, there is a paucity of quantitative studies about the socioeconomic consequences of armed conflict at the micro-level, i.e., noncommitted local households and civilians.     

Mortality, violence and access to care in two districts of Port-au-Prince, Haiti

Background  

Towards the end of 2006 open conflict broke out between United Nations forces and armed militia in Port-au-Prince, Haiti. Fighting was most intense in the district of Cité Soleil.     

Prevalence of and factors influencing posttraumatic stress disorder among mothers of children under five in Kabul,Afghanistan, after decades of armed conflicts

Background  

In the period following wars and other forms of armed conflict, health and quality of life of mothers is a major concern as they have the closest contact with children. The present study was performed to examine the impact of exposure to events related to armed conflicts on post traumatic stress disorder (PTSD) among women raising children, and to identify factors that alleviate the negative consequences of exposure to traumatic events.     

The association between armed conflict,violence and mental health: a cross sectional study comparing two populations in Cundinamarca department,Colombia

Background

Exposure to violence in general and to armed conflict in particular has been consistently associated with an increased prevalence of mental illness. Colombia has sustained an internal armed conflict for decades and is considered one of the most violent countries in the world. However, certain areas have been more exposed to the conflict than others.

Methods

This is a cross sectional study comparing two communities from different villages in the department of Cundinamarca, Colombia. One, Guasca, was directly impacted by armed conflict. The other one; Guatavita has never been affected by armed conflict. We applied two different instruments: the PHQ scale and a short standardized interview in order to estimate the prevalence of major psychiatric disorders and their link to violent events. Forty-two volunteers from each village were evaluated through a personal interview using these two instruments.

Findings

Of the population surveyed in Guatavita, 2.4% reported direct exposure to violence compared to 23.8% from Guasca. In the population exposed directly to violent events, the prevalence of all disorders was greater than in the non-exposed population with an OR of 1.46 (95% CI 0.3809 - 5.5989) for anxiety; 4.54 (95% CI 1.1098 - 18.5984) for depression; 6.0 (95% CI 1.2298 - 30.2263) for somatization disorder; and 4.4 (95% CI 1.2037 - 16.0842) for alcohol abuse.

Interpretation

There is a statistically significant association between the history of armed conflict, violence and the presence of mental illnesses, particularly depression, somatization disorder and alcohol abuse. Special attention should be paid to the detection, prevention and treatment of these disorders when dealing with populations exposed to violence and to armed conflict in particular.

     

Understanding effects of armed conflict on health outcomes: the case of Nepal

Objective  

There is abundance of literature on adverse effects of conflict on the health of the population. In contrast to this, sporadic data in Nepal claim improvements in most of the health indicators during the decade-long armed conflict (1996-2006). However, systematic information to support or reject this claim is scant. This study reviews Nepal's key health indicators before and after the violent conflict and explores the possible factors facilitating the progress.     

Armed conflict,alcohol misuse,decision-making,and intimate partner violence among women in Northeastern Uganda: a population level study

Background

Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest.

Methods

We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n?=?558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data.

Results

Most respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women’s partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI?=?0.989; TLI?=?0.989). The absolute fit (RMSEA?=?0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a₁b₁?=?0.209 [0.017: 0.467]).

Conclusions

This study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence—a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.

     

Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study

Background  

The aim of this study was to establish the prevalence of posttraumatic stress disorder (PTSD) and depression among Rwandese and Somali refugees resident in a Ugandan refugee settlement, as a measure of the mental health consequences of armed conflict, as well as to inform a subsequent mental health outreach program. The study population comprised a sample from 14400 (n = 519 Somali and n = 906 Rwandese) refugees resident in Nakivale refugee settlement in South Western Uganda during the year 2003.     

Assessing the Impact of Violence and War on Youth in Low- and Middle-Income Countries

Background

Research is needed to understand the effects of violence and armed conflict in low- and middle-income countries, though there are logistical and ethical concerns that should be taken prior to study design.

Objective

This paper provides commentary on some of the challenges inherent in conducting research with youth affected by war in low- and middle-income countries.

Method

A practical discussion of the need of psychosocial research with youth from low-and middle-income countries, determining priorities for research on violence using a mental health needs assessment, and the importance of service linked to research in low-resource countries.

Results and Conclusion

Understanding the practical and ethical concerns of conducting research for youth exposed to violence and armed conflict can assist in producing studies that are powerful tools to advocate for those affected by trauma in low- and middle-income countries.     

Understanding processes of risk and protection that shape the sexual and reproductive health of young women affected by conflict: the price of protection

Background

It is assumed that knowing what puts young women at risk of poor sexual health outcomes and, in turn, what protects them against these outcomes, will enable greater targeted protection as well as help in designing more effective programmes. Accordingly, efforts have been directed towards mapping risk and protective factors onto general ecological frameworks, but these currently do not take into account the context of modern armed conflict. A literature overview approach was used to identify SRH related risk and protective factors specifically for young women affected by modern armed conflict.

Processes of risk and protection

A range of keywords were used to identify academic articles which explored the sexual and reproductive health needs of young women affected by modern armed conflict. Selected articles were read to identify risk and protective factors in relation to sexual and reproductive health. While no articles explicitly identified ‘risk’ or ‘protective’ factors, we were able to extrapolate these through a thorough engagement with the text. However, we found that it was difficult to identify factors as either ‘risky’ or ‘protective’, with many having the capacity to be both risky and protective (i.e. refugee camps or family). Therefore, using an ecological model, six environments that impact upon young women’s lives in contexts of modern armed conflict are used to illustrate the dynamic and complex operation of risk and protection – highlighting processes of protection and the ‘trade-offs’ between risks.

Conclusion

We conclude that there are no simple formulaic risk/protection patterns to be applied in every conflict and post-conflict context. Instead, there needs to be greater recognition of the ‘processes’ of protection, including the role of ‘trade-offs’ (what we term as ‘protection at a price’), in order to further effective policy and practical responses to improve sexual and reproductive health outcomes during or following armed conflict. Focus on specific ‘factors’ (such as ‘female headed household’) takes attention away from the processes through which factors manifest themselves and which often determine whether the factor will later be considered ‘risk inducing’ or protective.

     

Household exposure to violence and human rights violations in western Bangladesh (II): history of torture and other traumatic experience of violence and functional assessment of victims

Background  

Organised crime and political violence (OPV) and human rights violations have marred Bangladesh history since 1971. Little is known about the consequences for the oppressed population. This study describes the patterns of OPV and human rights violations in a disturbed area of Bangladesh and assesses the physical, emotional and social functioning of victims.     

Conflict and user involvement in drug misuse treatment decision-making: a qualitative study

Background  

This paper examines client/staff conflict and user involvement in drug misuse treatment decision-making.     

Malaria control in Timor-Leste during a period of political instability: what lessons can be learned?

Background  

Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.     

Community based rehabilitation: a strategy for peace-building

Background  

Certain features of peace-building distinguish it from peacekeeping, and make it an appropriate strategy in dealing with vertical conflict and low intensity conflict. However, some theorists suggest that attempts, through peace-building, to impose liberal values upon non-democratic cultures are misguided and lack an ethical basis.     

Conflict among Iranian hospital nurses: a qualitative study

Background  

This study aims to explore the experience of conflict as perceived by Iranian hospital nurses in Tehran, Islamic Republic of Iran. Although conflict-control approaches have been extensively researched throughout the world, no research-based data are available on the perception of conflict and effective resolutions among hospital nurses in Iran.     

Factors associated with attitudes towards intimate partner violence against women: a comparative analysis of 17 sub-Saharan countries

Background  

Violence against women, especially by intimate partners, is a serious public health problem that is associated with physical, reproductive and mental health consequences. Even though most societies proscribe violence against women, the reality is that violations against women's rights are often sanctioned under the garb of cultural practices and norms, or through misinterpretation of religious tenets.     

Homicides and territorial struggles in Rio de Janeiro favelas

OBJECTIVE

To evaluate the risk of homicide in Rio de Janeiro’s favelas, taking into account the territorial disputes taking place in the city.

METHODS

The study is based on data on mortality from homicide in the city of Rio de Janeiro between 2006 and 2009. Risks in favelas and in surrounding areas were evaluated, as was the domination of armed groups and drug dealing. Geographic and ethnographic concepts and methods were employed, using participant observation, interviews and analysis of secondary data on health.

RESULTS

Within the favelas, mortality rates from homicide were equivalent to, or lower than, the rest of the city, although they were considerably higher in areas surrounding the favelas, especially in areas where there was conflict between armed rival gangs.

CONCLUSIONS

The presence of trafficking crews and turf war in strategic areas of the city increases homicide rates and promotes the “ecology of danger” in these areas.     

Short and longer-term psychological consequences of Operation Cast Lead: documentation from a mental health program in the Gaza Strip

Background

There is growing recognition of the psychological impact of adversity associated with armed conflict on exposed civilian populations. Yet there is a paucity of evidence on the value of mental health programs in these contexts, and of the chronology of psychological sequelae, especially in prolonged conflicts with repeated cycles of extreme violence. Here, we describe changes in the psychological profile of new patients in a mental health program after the military offensive Cast Lead, in the context of the prolonged armed conflict involving the Gaza Strip.

Methods

This study analyses routinely collected program data from a Médecins Sans Frontières mental health program in the Gaza Strip spanning 2007?C2011. Data consist of socio-demographic as well as clinical baseline and follow-up data on new patients entering the program. Comparisons were made through Chi square and Fisher??s exact tests, univariate and multivariate logistic and linear regression.

Results

PTSD, depression and other anxiety disorders were the most frequent psychopathologies, with 21% having multiple diagnoses. With a median of nine sessions, clinical improvement was recorded for 83% (1122/1357), and more common for those with separation anxiety, acute and posttraumatic disorders as principal diagnosis (855/1005), compared to depression (141/183, p<0.01). Noted changes proximal to Operation Cast Lead were: a doubling in patient case load with a broader socio-economic background, shorter interval from an identified traumatic event to seeking care, and a rise in diagnoses of acute and posttraumatic stress disorders. Sustained changes included: high case load, more distal triggering events, and increase in diagnoses of other anxiety disorders (especially for children 15 years and younger) and depression (especially for patients 16 years and older).

Conclusion

Evolving changes in patient volume, diagnoses and recall period to triggering events suggest a lengthy and durable effect of an intensified exposure to violence in a context of prolonged conflict. Our findings suggest that mental health related humanitarian relief in protracted conflicts might need to prepare for an increase in patients with changing profiles over an extended period following an acute flare-up in violence.     

Persistent work-life conflict and health satisfaction - A representative longitudinal study in Switzerland

Background  

The objectives of the present study were (1) to track work-life conflict in Switzerland during the years 2002 to 2008 and (2) to analyse the relationship between work-life conflict and health satisfaction, examining whether long-term work-life conflict leads to poor health satisfaction.